Doctor Answers 12

Skin removal from the lower eyelids- be careful what you wish for

May 16th, 2011

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You should sit down and write a note to your plastic surgeon and thank him for not butchering your lower eyelids by removing too much skin.
Patients who are fixated on achieving tight lower eyelids will eventually get their wish, along with the round eye deformity or ectropion.
Often a little skin pinch leads to a little alteration in eye shape.
The lower eyelid is a weak structure and generally will not tolerate resection of skin unless a cheek lift or lower eyelid support are simultaneously undertaken.
There are several articles and chapters referenced on this topic.

Lower Eyelid Revision after Blepharoplasty is very risky

June 11th, 2011

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As the other doctors have mentioned, secondary revision of lower eyelid Blepharoplasty is very risky. If too much skin is removed or scarring occurs you could be left with an ectropion a very serious complication.

See an expert who does a lot of eyelid surgery and respect his/her opion. An experienced doctor can tell you if further surgey is indicated.

If you have excess fat left after a lower Blepharoplasty, the fat can be removed from an inside incision called a Transconjunctival Blepharoplasty which does not violate the supporting structures of the lower eyelid.

If you have good lower eyelid support, your eyelid is not lax, in some cases a judicious and careful laser Resurfacing using Fractional Ablative 2940 Erbium Laser can improve the lower eyelid skin after Blepharoplasty-but this should e done by an experienced, expert eyelid surgeon

Still skin and fat after eyelid surgery

May 18th, 2011

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Five and a half months should be long enough to see the final result and have a revision eyelid surgery to remove the residual fat and loose skin. Be careful not to have a revision lower eyelid surgery through the lower eyelid skin as this has a high rate of lower lid malposition that makes the eye shape appear changed and smaller in size.

Eyelid Surgery Pictures

Caution is needed for lower lid revision

May 17th, 2011

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The best advice for lower eyelid revision is to wait at least a year to see if the lid will smooth out. Skin removal in the lower lid must always be approached with caution. It is quite easy to produce a pull on the lower lid line with show of the white of the eye, dry eye, or an ectropian, where the lid is poorly supported and pulled away from the eye. Be patient, and be careful with your expectations.

Skin Removal in Lower Lid Blepharoplasty

May 16th, 2011

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One of the worst things a Surgeon can do to a patient is over aggressive lower eyelid skin removal during Blepharoplasty. The lower eyelid is only responsible for 5-10% of eyelid closure and is an inherently weak structure. Incisional surgery obviously leads to wound contraction during the healing process. Wound contracture on a relatively weak structure which is further weakened by skin removal can lead to lid retraction, and sometimes ectropion. The end result is a poor cosmetic result, and sometimes functional impairment of the eyelid. Frequently, the lines (rhytids) beneath the lower lids are better treated by laser resurfacing than aggressive skin removal. 5 months after your procedure, further skin removal shouldn't be in the cards. Definitely voice your concerns with your Surgeon and try to be patient.

Revision Eyelid Surgery

May 16th, 2011

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I would recommend waiting at least 6 months after your last blepharoplasty before considering revision surgery. It is possible that other problems such as laxity of the brow could be the cause of the problem. I would recommend a careful discussion with your surgeon regarding the goals that were not met with the surgery to determine what further treatment is needed.

Extra skin on lower lids

May 16th, 2011

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Your surgery was still fairly recent. At this stage it would be too soon to consider doing anything further, but I would echo what some of the other surgeons have said: it is far better to have taken too little than too much.

This may have absolutely nothing to do with the skin.

May 16th, 2011

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It is great when we are all on the same page. I read your question and answered to myself that with "too much skin left," you could wait forever before having it revised. If you have had lower eyelid surgery and have had no benefit, then perhaps your surgeons diagnosis of what your issues were was incorrect. Perhaps your surgeon just did very conservative surgery for which I for one, do not fault them. The fact of the matter is that what makes up the lower eyelid issues is very complex. WIthout a personal consultation, none of us writing here are going to know what precisely you need. However, I would recommend that you seek additional consultations, proceed cautiously, and don't make your last surgeon do something they do not want to do.

Be Very Careful about repeat Eyelid Surgery

May 16th, 2011

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If would be of much benefit if you post before and after pictures or even just your after pictures. It is way too soon to consider any revision surgery. Eyelids are very sensitive and if you overdo it, you may have lifelong problems with your eyes. You should wait at least six months and then have a very careful and detailed discussion with your surgeon.

These answers are for educational purposes and should not be relied upon as
a substitute for medical advice you may receive from your physician. If you
have a medical emergency, please call 911. These answers do not constitute
or initiate a patient/doctor relationship.